Generalised Anxiety Disorder (GAD)

Question 1

define GAD

Answer 1

Generalised anxiety disorder (GAD) is a

1)common condition defined as
2)chronic, 3) excessive worry 4) for at least 6 months that causes
5) distress or impairment, 6) and is hard to control.

Question 2

what are the core symptoms of anxiety disorder and how many are needed for diagnosis

Answer 2

• Muscle tension- common
• Irritability- common
• Restlessness- common
• Sleep disturbance
• Fatigue
• Poor concentration

Question 3

what are some other possible symptoms

Answer 3

• Headache
• Sweating
• Dizziness
• GI symptoms
• Trembling

Question 4

risk factors of anxiety?

Answer 4

• Family history of anxiety
• Female
• Increased stress
• History of physical or emotional trauma
• Comorbid depression
• Substance misuse/dependence
• Other anxiety disorder
• Divorced/separated
• Living alone
• Being lone parent

Question 5

What should you always do when considering a psychiatric diagnosis?

Answer 5

rule out any physical causes

Question 6

what are some potential physical causes of anxiety?

Answer 6

hyperthyroidism, cardiac disease, medication induced anxiety

Question 7

what are some medications that can cause anxiety

Answer 7

salbutamol, theophylline (anti wheezing), corticosteroids, antidepressants and caffeine

Question 8

How do you rule out physical causes?

Answer 8

by doing investigations.:
(some common ones:)
- Hyperthyroidism through doing TFTs

• urine drug screen

Question 9

what are the first 4 steps of anxiety disorder management

Answer 9

step 1: education about GAD + active monitoring

step 2: low-intensity psychological interventions (individual non-facilitated self-help or guided or psychoeducational groups)

step 3: high-intensity psychological interventions (CBT or applied relaxation)
ORR drug treatment.

step 4: highly specialist input e.g. Multi agency teams

Question 10

What is the first line medication considered for anxiety

Answer 10

sertraline should be considered the first-line SSRI

Question 11

what to consider if sertraline is ineffective

Answer 11

alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI) ex. duloxetine, venlafaxine

Question 12

If the person cannot tolerate SSRIs or SNRIs?

Answer 12

consider offering pregabalin

Question 13

what does NICE suggest you do for patients under 30?

Answer 13

1) warn patients of the increased risk of suicidal thinking and self-harm.

2) Weekly follow-up is recommended for the first month

Question 14

complications?

Answer 14

• Comorbid depression
• Comorbid substance misuse

Question 15

prognosis?

Answer 15

With proper treatment, a decrease in symptoms, improved psychosocial functioning, and a reduction in over-utilisation of medical care can be achieved

GAD may recur under physical or emotional stress

Question 16

(when) can mirtazapine be given for GAD?

Answer 16

its a NaSSA, noradrenaline and serotonin selective antidepressant, and this class is not suggested for GAD

Question 17

what class is venlafaxine?

Answer 17

SNRI

Question 18

what is the max dose of sertraline?

Answer 18

200mg per day

Question 19

what class is diazepam? when do we give that?

Answer 19

A benzodiazepine, not given for treatment of GAD in primary or secondary care, exception can be during crisis

Question 20

list SSRIs

Answer 20

sertraline
Citalopram
dapoxetine
escitalopram
fluoxetine
fluvoxamine maleate
paroxetine

Question 21

list SNRIs

Answer 21

Venlafaxine
Duloxetine
(Natrexone with buproprion
Buproprion hydrochloride )
i think these two not suggested for GAD but are unofficially tried sometimes